1 preoperative nursing
1. 1 Patients in basic nursing should pay attention to nutritional supplement before operation, encourage patients to adopt a digestible diet with high nutrition, high vitamins and low fat, and ensure adequate sleep. Skin preparation before operation, iodine allergy test and fasting for 4 hours before operation. Improve all kinds of preoperative examinations. After the patient is admitted to the hospital, the responsible nurse is responsible. In order to make the interventional therapy safe and smooth, and reduce the side effects, the nurse in charge must master the relevant information of the patient before the treatment, such as the patient's condition and psychological state. Development and treatment of diseases; The patient's understanding of the current treatment plan, etc. At the same time, the patient's physical condition should be evaluated, including nutritional status, physical examination and laboratory examination. For people with poor physical condition, such as extreme emaciation, anemia, and lower platelets and white blood cells, support treatment should be strengthened first, and this treatment should be carried out after the physical condition improves.
1.2 preoperative nursing
(1) knowledge education: provide patients and their families with knowledge about disease treatment and rehabilitation and professional nursing guidance, guide patients to self-care according to related nursing problems, help establish an effective knowledge system and master self-care skills.
(2) Health education: Most patients with advanced lung cancer have psychological barriers to varying degrees, and lack confidence in interventional therapy, showing doubts, fears and nervousness. The nurse in charge must patiently and meticulously do a good job in psychological counseling and explanation, explain in detail the basic treatment principles and procedures of interventional therapy, care for patients, relieve their pain in time, and make patients receive treatment in the best state. Explain the importance and necessity of bed rest and limb fixation after operation to patients and their families, and train patients to defecate in bed.
(3) Routine preparation before operation: routine examination of liver, renal function, blood routine and prothrombin time before operation, fasting water for 6 hours before operation, instructing patients to wash the skin at the puncture site, and preparing bilateral groin skin. Do iodine, penicillin and procaine allergy test according to the doctor's advice.
1.3 In psychological nursing intervention, most patients showed irritability, fear, anxiety and pessimism. They are skeptical about treatment, or have too high expectations for treatment. If preoperative health education and psychological care are not in place, it will seriously affect the therapeutic effect. Moreover, most patients with liver cancer don't know their own condition, so medical staff should communicate with patients and their families, understand patients' understanding of the disease and their psychological reactions, carry out targeted psychological care, and make effective health education plans according to patients' individual needs. For patients with sound psychology, optimism and knowledge of diseases, nurses give more encouragement, patiently and meticulously explain the process of interventional therapy, possible side effects and treatment principles, increase patients' confidence in overcoming diseases and improve their self-protection ability. Nurses should be cautious, euphemistic and optimistic when communicating with patients who are psychologically fragile and ignorant of the disease, arouse the enthusiasm of patients, convey positive mental state to patients, improve their psychological defense ability, communicate with their families, obtain their cooperation, and establish a nurse-patient relationship with participation, thus improving the treatment effect.
2 Intraoperative nursing
In the process of interventional therapy, nurses should not only do psychological care for patients, but also closely observe the operation of injected drugs and embolic agents to avoid the backflow of embolic agents to non-target blood vessels. Closely observe the changes of patients' vital signs. If there are symptoms such as irritability, chills and cyanosis. , immediately increase the oxygen flow and concentration, and make emergency preparations; Observe whether there is expectoration and sputum secretion at any time and deal with it in time.
3 postoperative care
3. 1 Nursing the patient in bed for 24 hours at the puncture point, pressurizing the salt bag at the puncture point for 6 hours to avoid wound infection caused by dust leakage from sandbags, and instructing the patient to straighten his limbs at the operation side for 8 hours. Closely observe the skin temperature of limbs, pulse of dorsalis pedis artery, skin color of operation side, observe whether there is congestion and hematoma on the skin at the puncture point, whether the dressing is pollution-free, and whether the salt bag is displaced. If any abnormality is found, handle it in time.
Postoperative care:
(1) Nursing care of local puncture: The most common complication of interventional therapy is puncture of local hematoma, so the puncture point is pressed 15min after operation, and then the puncture point is pressed with bandage. The surgical limb is braked in the straight position for 8h, and the patient stays in bed 12h. Closely observe the puncture site for oozing blood and subcutaneous blood stasis. If there is oozing blood, change the dressing in time and keep the puncture site dry to prevent infection.
(2) Closely observe the changes of patients' vital signs: After operation, we should pay attention to the changes of patients' body temperature, pulse, blood pressure and limb color, especially the changes of dorsal foot artery pulsation, peripheral blood supply and skin temperature.
(3) Hydration nursing: Due to local infusion of high-dose anticancer drugs, the side effects are obvious, and hydration treatment is particularly important. Intravenous infusion of 2500~3000ml every day within 3 days after operation, and the dropping speed is adjusted according to the patient's condition, 60 ~ 80 drops/minute, such as the elderly or patients with cardiac and renal insufficiency. Encourage patients to drink more water, drink no less than 2500ml every day and urinate more than 3000ml, so that drug toxins can be excreted through the kidneys as soon as possible.
(4) Body temperature monitoring: closely observe the changes of body temperature, give physical cooling in time according to the condition, and use drugs to cool down if necessary. When sweating for a long time, change sheets, sheets and underwear for patients in time, and do a good job in oral and skin care.
(5) Nursing care of gastrointestinal reaction: After operation, people should fast for 4 ~ 6h, because the adverse reaction of chemotherapy drugs may cause nausea and vomiting. Do a good job of explanation in nursing, and give metoclopramide and comfortable injection to reduce gastrointestinal reaction. Diet should be light, a small amount of meals, strengthen oral care, reduce bad stimulation and promote toxin excretion.
(6) Pain nursing: within 2 ~ 3 days after interventional therapy, tumor necrosis can cause pain in tumor area. Nurses should do a good job of appeasing patients while strengthening the observation of their illness. When the pain is unbearable, closely observe the location, nature and degree of the pain so as to distinguish it from the pain caused by other complications, and use painkillers according to the doctor's advice if necessary.
3.2 Observation and Nursing of Complications Post-embolization syndrome is a common complication after embolization treatment, mainly manifested as fever, abdominal pain, nausea, vomiting and paralytic flatulence. Nurses should closely observe the changes of patients' vital signs, patrol the ward every 30 minutes 1 time, and take the temperature 1 time every 4 hours. The fever after embolization generally does not exceed 38.5℃, and it can gradually return to normal within 1 week. If the body temperature is too high, give alcohol bath and ice compress in time, if necessary, give drugs to cool down, keep warm, prevent catching cold, replenish water in time, and avoid collapse due to excessive cooling. In order to prevent infection, antibiotics can be used before and after operation. When the right epigastric pain is severe, use painkillers. Pay close attention to the changes of dyspnea, expectoration, cyanosis, respiratory frequency, heart rate and heart rhythm, and handle any abnormality in time.
4 discussion
Interventional therapy technology is a safe and effective treatment technology, through the implementation of holistic nursing for 500 patients with liver cancer interventional therapy. It shows that systematic preoperative education, detailed and specific preoperative guidance and effective postoperative care can alleviate patients' anxiety, make patients receive treatment safely, successfully pass the reaction period of interventional chemotherapy drugs, relieve pain, improve patients' quality of life and realize the strong guarantee of expected treatment. It is the key to ensure the success of the operation and reduce complications. Encourage patients to establish self-confidence, maintain an optimistic and cheerful attitude, enhance their subjective initiative to overcome cancer, and at the same time, eat reasonably, enhance nutrition, exercise properly, and enhance the body's disease resistance. Take medicine on time and go to the hospital regularly.
At present, there may not be any medicine to save it. Traditional Chinese medicine may also have a psychological effect, because HCC is mostly produced in sclerosing nodules, and it is also common in Shuang Ye's liver. Because HCC grows in the liver, the liver is more sensitive to toxicity than chemicals, and it often invades the portal vein, which makes chemotherapy impossible and inefficient for it.
The current goal is not only to prolong life, but to maintain your grandmother's quality of life in the last time and try to alleviate the pain. These include liver puncture and alcohol injection into cancer tissue, embolization chemotherapy (because it is a vascular tumor and needs blood vessels to provide living conditions, people found its weakness), rapid freezing or electric frequency heating to kill cancer cells. If vitamin K and other substances can be used earlier, the formation of portal vein embolism can be delayed (invented in Japan). Japan also found that formic acid drugs (a kind of vitamin A) may be beneficial, estrogen inhibitors (ineffective for men) also benefited some people in hormone therapy experiments, and proton irradiation and arterial irradiation could relieve pain. If these treatments are effective, jaundice or ascites should be improved.